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Feverfew

 

Feverfew Introduction

Tanacetum parthenium is the plant commonly referred to as feverfew or chrysanthemum. It is a member of the Asteraceae or daisy family. [1] Botanically, the plant appears as a short, bushy perennial, with yellow-green leaves and yellow flowers that look similar to the flowers of chamomile. [2] The leaves are used medicinally, and it has been said that preparations of feverfew taste bitter, aromatic, and slightly sweet. Feverfew originated in Europe and the Balkan Peninsula, and is also reported to have grown around the Greek Parthenon, hence its name. [3]

Feverfew’s popularity resulted from an article published in Prevention magazine in 1978. The article highlighted a woman, Anne Jenkins, whom for years has used the plant to treat her migraine headaches.[4] She was an advocate and strong proponent for the medicinal use of feverfew. Her passion, along with that of many others, resulted in the Migraine Trust of the United Kingdom to begin research on feverfew’s medicinal relevance.

There are a number of compounds in feverfew responsible for its medicinal activity. Volatile oils make up a vital component, with the most significant oils being L-camphor and trans-chrysanthylacetate. Other volatile oils include camphene, p-cymene, linalool, borneol, and terpenes-4-ol. Feverfew also contains sesquiterpene lactones (mostly parthenolide), flavonoids, and polyenes. [5]

The sesquiterpene lactone, parthenolide, appears to play a significant role in the pharmacology of this plant in relation to pain; more specifically, migraine headaches. Parthenolide accounts for nearly 85% of the sesquiterpene lactone content found in feverfew. [6] This compound possesses anti-platelet activity which prevents platelets from aggregating or sticking together. [7] It also inhibits the release of serotonin and other chemical mediators of inflammation from platelets. This is important for migraine headache sufferers, as such attacks are thought to be triggered by a significant increase in serotonin caused by platelets. Furthermore, feverfew also interacts with the protein kinase C pathway, which may also be responsible for the anti-migraine activity of this plant.

Regarded by most as mainly an anti-migraine herb, feverfew possesses a number of medicinal actions, including:

  • diaphoretic (increases perspiration)
  • anti-inflammatory*
  • emmenogogue (promotes menstruation)
  • anti-helmintic (destroys parasites)
  • bitter
  • anti-histamine
  • decreases platelet aggregation
  • serotonin release

Traditionally, feverfew has been used by herbalists to treat conditions of the gastrointestinal tract (e.g. parasitic worms), as an immune stimulant, for various gynecologic conditions, and in the treatment of renal (kidney) disorders. [8, 9] Feverfew was also included in miscellaneous topical applications, used to address musculoskeletal conditions like sprains and rheumatic disorders.

*The anti-inflammatory activity results from the inhibition of chemical inflammatory mediators including prostaglandins, leukotrienes, and thromboxanes.

  

Feverfew Uses

The bulk of scientific research on feverfew has focused on the treatment of migraine headaches. An initial survey conducted by a migraine specialist, Dr. Stewart Johnson, concluded that 72% of patients indicated that feverfew helped prevent their migraine attacks; 78% of this percentage of patients suffering from tension headaches found feverfew to decrease the frequency and severity of attacks; 33% of which noticed complete disappearance of attacks. [10] Other significant findings included reductions in associated nausea and vomiting, lower proportion of patients with aura, improved response to conventional pain medications, relief of arthritis symptoms and no noted interactions with prescription medications. Side effects were minimal. Some subjects experienced improved digestive function, sleep, and an overall sense of well-being.

Double-blind, placebo-controlled studies have supported the results of this initial survey. One such study was conducted with migraine patients who had been effectively self-medicating with raw feverfew every day for 3 months. [11, 12] These subjects were given 25 milligrams (mg) of a freeze-dried leaf preparation or placebo, for six 4 week periods. The results showed that the patients who received the placebo had a significant re-emergence of migraine attacks, with associated nausea and vomiting.

Another clinical trial was carried out in patients with classic or common migraine. [13] These patients were given powdered freeze-dried capsules of feverfew, containing 2.2╬╝mol parthenolide, or placebo for 4 months. They were then switched over to the other treatment protocols for another 4 month period. Again, the results demonstrated that treatment with feverfew significantly reduced the mean number of attacks and associated vomiting. No adverse effects were noted.

Feverfew has demonstrated significant anti-microbial activity, as observed with in vitro experiments. Antibacterial activity against Staphylococcus aureus, Escherichia coli, and Salmonella spp. has been documented using a particular category of constituents, namely, eudesmanolides. [14] The volatile oil component also was shown to effectively inhibit the bactericidal and fungicidal activity of some 27 microorganisms tested. [15]

Based on its extensively studied anti-inflammatory activity, feverfew could also be used to treat conditions associated with inflammation. Although, one double-blind, placebo-controlled clinical trial conducted in patients with rheumatoid arthritis did not demonstrate any benefit in the groups taking feverfew, further trials need be carried out; to examine other inflammatory conditions, dosage levels, and treatment durations. [16]

Other conditions for which feverfew may be useful include; relieving dysmenorrheal (menstrual cramps), hyperlipidemia, bronchoconstrictive disorders, psoriasis, facilitation of the third stage of labor, and fever reduction. [17-19]

Feverfew Dosages

Extracts of feverfew are generally standardized to contain a particular amount of parthenolide content. The Health Protection Branch of the Health and Welfare Department of Canada mandates that preparations contain 0.2% of this constituent. For the treatment of migraine headaches, a typical dose would be 250 milligrams of parthenolide daily. [3] If using dried leaf, it should contain 0.2% parthenolide, as mentioned, administered in dosages of 125 milligrams daily. Treatments should be continued for a minimum duration of at least 4 - 6 weeks, to accurately assess the effect of applied dosages. Treatment times will vary among patients, and then must be continued as prophylaxis. Clinical studies have shown that it may take in excess of 4 - 6 months to accurately assess efficacy. [20]

Feverfew Toxicities and Contraindications

Feverfew is contraindicated in pregnancy due to its potential emmenagogue effect, and also in nursing mothers. It should never be administered to children under the age of 2. If taking prescription medications for migraines, feverfew treatment should be discussed with a physician. [3]

Feverfew may cause contact dermatitis and ulceration of the mucous membranes, if chewing the leaves. [21] This usually does not occur with capsule and tincture preparations. Minor gastrointestinal upset and nervousness may also occur. Long-term toxicity studies have not been conducted. Extreme overdose may induce a coma and possibly death through respiratory failure. [4]

References

1. Tilgner S. Herbal Medicine from the Heart of the Earth. Wise Acres Press, Inc. Creswell, OR, 1999:63.

2. Feverfew. Lawrence Review of Natural Products. September, 1994.

3. Brown DJ. Herbal Prescriptions for Better Health. Prima Publishing, Rocklin, CA 1996:91-95.

4. AANP. Nature’s Pharmacy- Your Guide to Healing Foods, Herbs, Supplements and Homeopathic Remedies. Publications International Ltd., Lincolnwood, IL 2001;130-131.

5. PDR for Herbal Medicines. Medical Economics Company Inc., Montvale, NJ. 2001

6. Hobbs C. Feverfew (Tanacetum parthenium). HerbalGram 1989;20:26-35.

7. Makheja AN and Bailery JM. A platelet phospholipase inhibitor from the medicinal herb feverfew (Tanacetum perthenium). Prostaglandisn, Leukotrienes Med 1982;8:653-660.

8. Cook WM. The Physio-Medical Dispensatory: a Treatise on Therapeutics, Materia Medica and Pharmacy. Eclectic Medical Publications, Sandy, OR 1985

9. Felter HW and Lloyd JU. King’s American Dispensatory, 18th ed. Eclectic Medical Publications, Sandy, OR 1983

10. Johnson ES. Feverfew (overcoming common problems). Sheldon Press, London, UK 1984:42-55.

11. Johnson ES et al. BR Med J(Clin Res Ed) 1985;291(6495):569-573.

12. Hylands DM et al. Br Med J (Clin Res Ed) 1985;291(6502):1128.

13. Murphy JJ et al. Lancet 1988;2(8604):189-192.

14. Stephanovic M et al. Sci Nat 1988;23:23-40.

15. Kalodera et al. Pharmazie 1997;52(11):885-886.

16. Pattrick M et al. Ann Rheum Dis 1989;48(7):547-549.

17. Hall IH et al. J Pharm Sci 1978;67(9);1235-1239.

18. Keery RJ and Lumley P. Br J Pharmacol 1986;89:834.

19. Hancock K. Feverfew. Your headache may be over. Keats Publishing, New Canaan 1986:36,47-51.

20. Mills S and Bone K. Principles and Practice of Phytotherapy. Churchill Livingstone, Edinburgh, UK 2000:385-393.

21. Brinker F. Herb Contraindications and Drug Interactions, 3rd ed. Eclectic Medical Publications, Sandy, OR 2001:71,146.